Experiences of Medicaid Programs and Health Centers in Implementing Telehealth.

Despite telehealth's potential to improve access to care, it is underutilized by safety-net providers, including Federally Qualified Health Centers (FQHCs), due to a range of policy, organizational, and logistical barriers. Research that facilitates state-to-state learning can inform both Medicaid and Medicare policies going forward and provide lessons learned for FQHCs interested in starting or expanding telehealth programs. The authors conducted telephone discussions with representatives of seven state Medicaid programs and 19 urban and rural FQHCs to address how FQHCs in selected states are using telehealth, how the delivery of telehealth services is structured, barriers and facilitators of telehealth, and how Medicaid policy influences telehealth implementation. Live video telehealth, typically telebehavioral health, was the most prevalent type of telehealth among FQHCs in the sample. Stakeholders highlighted several weaknesses of Medicaid policies in one or more states, including general lack of clarity regarding which services were allowed by Medicaid programs, ambiguity around telepresenter requirements, lack of authorization for FQHCs to serve as distant sites in the federal Medicare program and in select state Medicaid programs, and insufficient reimbursement. FQHC stakeholders also identified multiple barriers to telehealth implementation beyond reimbursement. Nonetheless, FQHC stakeholders generally believed they could overcome these various barriers to telehealth implementation, if reimbursement and the risk of losing revenue in offering telehealth services were improved. While diversity of experiences makes it difficult to generalize about implementation of telehealth in the safety net, the authors identified several common themes and associated considerations for policymakers, payers, and FQHCs.

Development and Maintenance of Standardized Cross Setting Patient Assessment Data for Post-Acute Care: Summary Report of Findings from Alpha 1 Pilot Testing.

The Centers for Medicare & Medicaid Services (CMS) contracted with the RAND Corporation to identify and/or develop standardized items to include in the post-acute care patient assessment instruments. RAND was tasked by CMS with developing and testing items to measure seven areas of health status for Medicare beneficiaries: (1) vision and hearing; (2) cognitive status; (3) depressed mood; (4) pain; (5) care preferences; (6) medication reconciliation; and (7) bladder and bowel continence. This article presents results of the first Alpha 1 feasibility test of a proposed set of items for measuring each of these health status areas. Conducted between August and October 2016, the test is one of two Alpha tests that will be completed by mid-2017 to assess the feasibility of proposed items. The results of these small-scale feasibility tests will inform a national Beta test designed to determine how well the measures perform when implemented in post-acute care settings. The Alpha 1 testing phase was successfully completed, in that all items were pilot tested among 133 patients. Items from all content areas were assessed on interrater reliability and feasibility; items from some content areas were assessed on other metrics. Items have now been revised, when necessary, based on the findings of the Alpha 1 test. Alpha 2 testing is under way with the updated, revised items.